ZIP Code
County
Applicant Info
Applicant
Date of birth
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Gender
male
female

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Zip Code	30044 (edit)
Applicant	2/23/1984 Male (edit)
Coverage Start	2/24/2019 (edit)

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Insurance Type	ACA (Obamacare)
Plan Name	KP GA Bronze 6200/40%/HSA
Plan ID	qhp-89942GA0050009
Plan Year	2019
Insurance Provider	Kaiser Permanente
Metal Level	Bronze
Plan Type	HMO
Deductible	$6,200
Out-of-Pocket Maximum	$6,550
Personal Score
Plan Highlights

Costs for Medical Care
Primary Care Visit to Treat an Injury or Illness	40% Coinsurance after deductible
Specialist Visit	40% Coinsurance after deductible
Laboratory Outpatient and Professional Services	40.00% Coinsurance after deductible
X-rays and Diagnostic Imaging	40.00% Coinsurance after deductible
Deductible - Family	$12400
Out-of-Pocket Maximum - Family	$13100

Prescription drug coverage
Generic Drugs	40% Coinsurance after deductible
Preferred Brand Drugs	50% Coinsurance after deductible
Non-Preferred Brand Drugs	50% Coinsurance after deductible
Specialty Drugs	50% Coinsurance after deductible

Access to doctors and hospitals
Provider directory URL	Coming Soon

Hospital services
Emergency Room Services	40% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)	40% Coinsurance after deductible
Inpatient Physician and Surgical Services	40% Coinsurance after deductible

Maternity
Prenatal and Postnatal Care	40.00% Coinsurance after deductible

Mental Health
Mental/Behavioral Health Outpatient Services	40.00% Coinsurance after deductible
Mental/Behavioral Health Inpatient Services	40.00% Coinsurance after deductible

Vision Coverage
Routine Eye Exam for Children	40.00% Coinsurance after deductible
Eye Glasses for Children	Not Applicable

Exclusions and Limitations
More Included Benefits	Outpatient Rehabilitation Services Habilitation Services Chiropractic Care Durable Medical Equipment Imaging (CT/PET Scans, MRIs) Preventive Care/Screening/Immunization Rehabilitative Speech Therapy Other Practitioner Office Visit (Nurse, Physician Assistant) Outpatient Facility Fee (e.g., Ambulatory Surgery Center) Outpatient Surgery Physician/Surgical Services Hospice Services Urgent Care Centers or Facilities Home Health Care Services Inpatient Physician and Surgical Services Skilled Nursing Facility Rehabilitative Occupational and Rehabilitative Physical Therapy Well Baby Visits and Care Transplant Accidental Dental Dialysis Allergy Testing Chemotherapy Radiation Diabetes Education Prosthetic Devices Infusion Therapy Treatment for Temporomandibular Joint Disorders Nutritional Counseling Reconstructive Surgery
More Excluded Benefits	Acupuncture Hearing Aids Routine Foot Care Weight Loss Programs Dental Check-Up for Children Infertility Treatment Long-Term/Custodial Nursing Home Care Private-Duty Nursing Bariatric Surgery Cosmetic Surgery Abortion for Which Public Funding is Prohibited

Exclusions and Limitations

More Included Benefits

Outpatient Rehabilitation Services
Habilitation Services
Chiropractic Care
Durable Medical Equipment
Imaging (CT/PET Scans, MRIs)
Preventive Care/Screening/Immunization
Rehabilitative Speech Therapy
Other Practitioner Office Visit (Nurse, Physician Assistant)
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Outpatient Surgery Physician/Surgical Services
Hospice Services
Urgent Care Centers or Facilities
Home Health Care Services
Inpatient Physician and Surgical Services
Skilled Nursing Facility
Rehabilitative Occupational and Rehabilitative Physical Therapy
Well Baby Visits and Care
Transplant
Accidental Dental
Dialysis
Allergy Testing
Chemotherapy
Radiation
Diabetes Education
Prosthetic Devices
Infusion Therapy
Treatment for Temporomandibular Joint Disorders
Nutritional Counseling
Reconstructive Surgery

More Excluded Benefits

Acupuncture
Hearing Aids
Routine Foot Care
Weight Loss Programs
Dental Check-Up for Children
Infertility Treatment
Long-Term/Custodial Nursing Home Care
Private-Duty Nursing
Bariatric Surgery
Cosmetic Surgery
Abortion for Which Public Funding is Prohibited

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KP GA Signature Bronze 6200/40%/HSA

$6,200.00

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$6,000.00

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Anthem Silver Pathway X HMO 6000

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Poddar, Satish

KP GA Bronze 6200/40%/HSA

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Benefits & Coverage

Costs for Medical Care

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Access to doctors and hospitals

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Maternity

Mental Health

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Exclusions and Limitations

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